University of York, York, England, UK.
University of Nottingham, Nottingham, England, UK.
BMC Health Serv Res. 2023 Jul 31;23(1):818. doi: 10.1186/s12913-023-09783-z.
Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services.
We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains.
Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care.
Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.
在结核病（TB）患者中，抑郁是常见的。尽管在大多数中低收入国家都有现成的、有效的治疗方法，但这种情况通常未被识别或未得到治疗。这些国家的结核病服务相对完善，为提供综合的抑郁筛查和护理提供了潜在的机会。然而，关于如何实现这种整合的证据有限。本研究旨在了解在结核病服务中整合抑郁护理的障碍和促进因素。
我们在孟加拉国、印度和巴基斯坦与 76 名研究参与者（包括结核病患者、他们的照顾者和卫生服务提供者）进行了九次研讨会，征求他们对将抑郁护理纳入结核病诊所的意见。我们使用演绎主题分析方法对翻译后的音频记录的转录本、孟加拉国和印度研讨会期间的即时记录以及巴基斯坦研讨会报告进行了分析。使用 SURE（支持使用研究证据）主题框架，我们将障碍和促进因素提取并分类到各个领域。
报告的将抑郁护理纳入结核病服务的障碍包括患者和工作人员对抑郁缺乏了解、经济负担以及结核病患者及其照顾者的相关耻辱感。政府对如何识别和筛查抑郁的认可和理解是被报告的潜在促进因素。此外，打破心理健康耻辱感并提供提供必要的额外资源（人力资源和咨询时间）来提供这项服务对于将抑郁和结核病护理相结合至关重要。
抑郁是结核病患者中常见的病症，需要在结核病患者中早期识别。卫生工作者将抑郁护理纳入结核病服务需要政治支持和资源的提供。
